7 Common Symptoms of Pelvic Organ Prolapse You Should Know

Pelvic organ prolapse is a common condition that occurs when one or more of the pelvic organs (such as the bladder, uterus, or rectum) drop from their normal position and bulge into or out of the vagina. This happens when the muscles and tissues supporting the pelvic organs become weak or stretched, often as a result of childbirth, aging, or other factors that put strain on the pelvic floor.

According to medical research, pelvic organ prolapse affects millions of women worldwide, particularly those who have given birth or are postmenopausal. The severity of prolapse can range from mild cases that cause minimal discomfort to severe cases that significantly impact quality of life. Recognizing the symptoms early is crucial for seeking appropriate medical care and preventing the condition from worsening.

In this article, we’ll explore the seven most common symptoms of pelvic organ prolapse, helping you understand what to look for and when to consult a healthcare provider.

1. A Feeling of Heaviness or Pressure in the Pelvis

One of the most frequently reported symptoms of pelvic organ prolapse is a persistent sensation of heaviness, pressure, or fullness in the pelvic region. Many women describe this feeling as if “something is falling out” or like they’re “sitting on a ball.” This uncomfortable sensation typically worsens as the day progresses and after prolonged periods of standing or physical activity.

The pressure feeling occurs because the prolapsed organs are pushing against the vaginal walls or even protruding through the vaginal opening in more advanced cases. This symptom can be particularly noticeable during activities that increase intra-abdominal pressure, such as:

• Lifting heavy objects
• Exercising or engaging in high-impact activities
• Coughing or sneezing
• Having bowel movements

Many women find temporary relief when lying down, as this position reduces the gravitational pull on the pelvic organs. The intensity of this pressure sensation often correlates with the severity of the prolapse.

2. Visible or Palpable Bulge in the Vagina

A vaginal bulge is one of the most distinctive and concerning symptoms of pelvic prolapse. This occurs when a prolapsed organ pushes against the vaginal wall, creating a noticeable protrusion that can sometimes be seen or felt at the vaginal opening. Some women discover this bulge while bathing, using the toilet, or during self-examination.

The characteristics of the bulge can vary depending on which organ has prolapsed:

• Cystocele (bladder prolapse): Creates a bulge in the front vaginal wall
• Uterine prolapse: The cervix or uterus descends into the vaginal canal
• Rectocele (rectal prolapse): Forms a bulge in the back vaginal wall
• Vaginal vault prolapse: Occurs after hysterectomy when the top of the vagina descends

In mild cases, the bulge may only be noticeable during straining or bearing down. In more severe cases, the tissue may protrude outside the body even at rest. This visible prolapse can cause significant emotional distress and anxiety for many women, but it’s important to know that effective treatment options are available.

3. Urinary Problems and Bladder Dysfunction

Bladder-related symptoms are extremely common in women with pelvic organ prolapse, particularly when the bladder is the prolapsed organ (cystocele). The altered position of the bladder and urethra can disrupt normal urinary function in several ways.

Common urinary symptoms associated with pelvic prolapse include:

• Stress urinary incontinence: Involuntary leakage of urine when laughing, coughing, sneezing, or exercising
• Urge incontinence: A sudden, intense need to urinate followed by involuntary leakage
• Difficulty emptying the bladder: Feeling unable to completely empty the bladder or needing to strain to urinate
• Frequent urination: Needing to urinate more often than usual, including multiple times during the night
• Weak or interrupted urine stream: Difficulty starting urination or a stream that stops and starts
• Recurrent urinary tract infections: Due to incomplete bladder emptying

Some women find that they need to manually reposition the prolapsed tissue (by inserting a finger into the vagina to push the bulge back) in order to fully empty their bladder. This symptom, while distressing, is relatively common in moderate to severe prolapse cases.

4. Bowel Difficulties and Constipation

When the rectum prolapses into the back wall of the vagina (rectocele), it can cause various bowel-related symptoms that significantly impact daily life. The structural changes in the pelvic anatomy can make normal bowel movements more challenging and uncomfortable.

Women with pelvic organ prolapse affecting the rectum may experience:

• Difficulty with bowel movements: Feeling unable to completely empty the bowels or needing to strain excessively
• Incomplete evacuation: A persistent feeling that the bowels haven’t fully emptied
• Need for manual assistance: Some women find they need to apply pressure on the vaginal wall or perineum (area between vagina and anus) to help evacuate stool
• Constipation: Hard, difficult-to-pass stools or infrequent bowel movements
• Fecal incontinence: In some cases, involuntary leakage of stool or gas
• Sensation of a blockage: Feeling as though something is obstructing the rectal passage

These bowel symptoms can create a frustrating cycle, as straining during bowel movements can actually worsen the prolapse over time. Managing constipation through diet, hydration, and lifestyle changes becomes particularly important for women with this condition.

5. Discomfort or Pain During Sexual Intercourse

Pelvic organ prolapse can significantly affect sexual function and intimacy, causing both physical discomfort and emotional concerns. Many women with prolapse report changes in their sexual experience, which can impact their quality of life and relationships.

Sexual symptoms related to prolapse may include:

• Dyspareunia: Pain or discomfort during vaginal penetration
• Reduced sensation: Decreased pleasure or feeling during intercourse due to changes in vaginal anatomy
• Awareness of the bulge: Feeling or noticing the prolapsed tissue during sexual activity
• Vaginal looseness: Sensation of reduced vaginal tone or tightness
• Partner awareness: Concerns about whether a partner can feel the prolapse
• Reduced lubrication: Changes in vaginal moisture that may accompany prolapse

Beyond the physical symptoms, many women experience psychological effects including embarrassment, anxiety about their condition being noticed, reduced self-esteem, and avoidance of sexual intimacy. It’s important to communicate openly with both healthcare providers and partners about these concerns, as they are common and can often be addressed.

6. Lower Back Pain and Discomfort

Chronic lower back pain is a frequently overlooked symptom of pelvic organ prolapse, but many women report persistent backache that seems to worsen throughout the day. This pain occurs because the prolapse alters the normal alignment and mechanics of the pelvic region, putting additional strain on the surrounding muscles, ligaments, and spine.

The characteristics of prolapse-related back pain typically include:

• Dull, aching sensation: Rather than sharp pain, most women describe a persistent ache in the lower back and sacral area
• Worsening with activity: Pain that intensifies after standing, walking, or physical exertion
• Relief when lying down: Many women notice the back pain improves significantly when resting in a reclined position
• Associated pelvic discomfort: The back pain often occurs alongside the pelvic pressure described earlier

The back pain associated with prolapse is believed to result from compensatory postural changes as the body attempts to adjust to the altered pelvic anatomy. Additionally, the weakened pelvic floor muscles can no longer provide adequate support to the spine and pelvis, leading to muscular fatigue and discomfort in the lower back region.

7. Increased Vaginal Discharge or Bleeding

Changes in vaginal discharge and occasional spotting or bleeding can occur with pelvic organ prolapse, particularly in more advanced cases. These symptoms develop when the prolapsed tissue protrudes from the vaginal opening and becomes irritated or damaged.

Discharge and bleeding symptoms may include:

• Increased vaginal discharge: Greater amounts of mucus-like discharge, which may be the body’s response to irritation of the prolapsed tissue
• Blood-tinged discharge: Light pink or brown discharge resulting from minor trauma to the exposed tissue
• Spotting or light bleeding: Small amounts of bleeding that occur when the prolapsed tissue rubs against clothing or becomes irritated during daily activities
• Tissue ulceration: In severe cases where tissue remains outside the body, it can develop sores or ulcers that may bleed or produce discharge
• Odor: Sometimes the discharge may have an unpleasant odor, particularly if the tissue has become irritated or infected

It’s important to note that while some discharge and mild spotting can be normal with prolapse, any significant bleeding, especially in postmenopausal women, should be evaluated promptly by a healthcare provider to rule out other conditions. The exposed prolapsed tissue is vulnerable to drying, irritation, and infection, which is why more severe cases may require medical intervention.

Main Causes of Pelvic Organ Prolapse

Understanding the underlying causes of pelvic organ prolapse can help women identify their risk factors and take preventive measures when possible. Prolapse occurs when the muscles, ligaments, and connective tissues that support the pelvic organs become weakened or damaged.

The primary causes and risk factors include:

• Pregnancy and childbirth: Vaginal delivery, especially of large babies or multiple births, is one of the strongest risk factors. The stretching and potential tearing of pelvic tissues during childbirth can compromise their supportive function.
• Aging and menopause: Declining estrogen levels after menopause lead to weakening of the pelvic floor muscles and connective tissues. Natural aging also reduces tissue elasticity and strength.
• Chronic increased abdominal pressure: Conditions or activities that repeatedly increase pressure in the abdomen can strain the pelvic floor over time, including:
  • Chronic coughing (from smoking, asthma, or bronchitis)
  • Chronic constipation and straining during bowel movements
  • Heavy lifting or strenuous physical labor
  • Obesity or being significantly overweight
• Genetic factors: Some women inherit naturally weaker connective tissue, making them more susceptible to prolapse even without other major risk factors.
• Prior pelvic surgery: Previous hysterectomy or other pelvic surgeries can disrupt the normal support structures and increase prolapse risk.
• Race and ethnicity: Research shows that Hispanic and white women have higher rates of prolapse compared to African American and Asian women, suggesting genetic predisposition plays a role.
• Neurological conditions: Diseases affecting nerve function can impair pelvic floor muscle control and coordination.

Often, pelvic organ prolapse results from a combination of these factors rather than a single cause. For example, a woman who has had multiple vaginal deliveries, is overweight, and experiences chronic constipation may be at particularly high risk.

Prevention Strategies for Pelvic Organ Prolapse

While not all cases of pelvic organ prolapse can be prevented, especially those related to genetics or unavoidable factors like aging, there are several evidence-based strategies that can significantly reduce your risk or prevent existing mild prolapse from worsening.

Maintain a healthy weight: Excess body weight increases chronic pressure on the pelvic floor. Achieving and maintaining a healthy BMI through balanced nutrition and regular exercise can reduce this strain considerably.

Practice proper lifting techniques: When lifting objects, always bend at the knees rather than the waist, engage your core muscles, and avoid holding your breath. Never lift anything heavier than you can comfortably manage, and ask for help when needed.

Prevent and treat constipation: Maintain regular bowel movements without straining by:

• Eating a high-fiber diet with plenty of fruits, vegetables, and whole grains
• Drinking adequate water throughout the day (at least 8 glasses)
• Establishing regular bathroom habits
• Avoiding prolonged sitting on the toilet
• Using a footstool to elevate your feet during bowel movements, which can ease passage

Perform pelvic floor exercises (Kegels): Regular pelvic floor muscle training can strengthen the muscles supporting your pelvic organs. To perform Kegels correctly:

• Identify the right muscles by stopping urination midstream (only for identification purposes, not as regular practice)
• Squeeze and hold these muscles for 3-5 seconds, then relax for 3-5 seconds
• Repeat 10-15 times per session, three times daily
• Breathe normally and avoid tightening stomach, thigh, or buttock muscles

Quit smoking: Smoking contributes to chronic coughing, which repeatedly stresses the pelvic floor. It also impairs tissue healing and collagen production, weakening pelvic support structures.

Treat chronic cough: If you have persistent coughing from allergies, asthma, or bronchitis, work with your healthcare provider to manage these conditions effectively.

Consider prenatal and postnatal care: For women who are pregnant or planning pregnancy:

• Attend prenatal pelvic floor physical therapy if available
• Discuss delivery options and their risks with your healthcare provider
• Begin gentle pelvic floor exercises after delivery (with medical clearance)
• Attend postnatal check-ups to assess pelvic floor recovery

Avoid high-impact activities if at risk: Women with early-stage prolapse or significant risk factors may benefit from choosing low-impact exercises like swimming, walking, or cycling over running, jumping, or heavy weightlifting.

Manage estrogen levels: Postmenopausal women should discuss with their healthcare provider whether hormone therapy might be appropriate for maintaining pelvic tissue health, considering individual benefits and risks.

Frequently Asked Questions

Can pelvic organ prolapse go away on its own?

Mild pelvic organ prolapse may improve with conservative measures like pelvic floor exercises, lifestyle modifications, and weight loss, but it typically doesn’t resolve completely without intervention. Once prolapse occurs, the weakened tissues rarely return to their original strength without treatment. However, symptoms can often be managed effectively, and progression can be prevented with appropriate care.

How do I know if I have mild or severe prolapse?

Prolapse severity is typically graded on a scale from 0 to 4. Mild prolapse (stages 1-2) means organs have descended but remain mostly inside the vagina, often causing minimal symptoms. Severe prolapse (stages 3-4) involves organs descending to or beyond the vaginal opening, usually with more noticeable symptoms. Only a healthcare provider can accurately assess the stage through physical examination.

Is pelvic organ prolapse dangerous or life-threatening?

Pelvic organ prolapse is generally not life-threatening, but it can significantly impact quality of life. Severe cases can lead to complications such as urinary retention, kidney problems (if urine cannot drain properly), recurrent urinary tract infections, or ulceration of exposed tissue. These complications underscore the importance of seeking medical evaluation rather than ignoring symptoms.

Can I still exercise if I have pelvic organ prolapse?

Yes, but you may need to modify your activities. Low-impact exercises like walking, swimming, cycling, and yoga are generally safe and beneficial. High-impact activities (running, jumping) and heavy weightlifting may worsen prolapse and should be approached cautiously. A pelvic floor physical therapist can help design an appropriate exercise program tailored to your specific condition and fitness goals.

Will pelvic organ prolapse affect my ability to get pregnant or give birth?

Mild to moderate prolapse doesn’t typically prevent pregnancy. However, pregnancy can worsen existing prolapse due to increased weight and pressure. Many women with prolapse have successful pregnancies and deliveries, though vaginal delivery may potentially worsen the condition. Discuss your specific situation with your healthcare provider when planning pregnancy to understand your individual risks and options.

When should I see a doctor about pelvic organ prolapse symptoms?

You should consult a healthcare provider if you notice any symptoms of prolapse, particularly a bulge in the vagina, persistent pelvic pressure, urinary or bowel difficulties, or pain during intercourse. Early evaluation allows for conservative treatment options that may prevent progression. Additionally, seek immediate medical attention if you experience complete inability to urinate, severe pain, or significant bleeding.

Can pelvic organ prolapse come back after treatment?

Yes, prolapse can recur even after treatment, whether conservative or surgical. Recurrence rates vary depending on the severity of the original prolapse, type of treatment, and continued presence of risk factors. This is why addressing underlying causes (like chronic constipation, obesity, or chronic cough) and maintaining pelvic floor strength through ongoing exercises is crucial for long-term management.

Does pelvic organ prolapse only affect older women?

While prolapse is more common in older women, particularly after menopause, it can affect women of any age. Younger women may develop prolapse following childbirth, especially after difficult deliveries or multiple pregnancies. Women with genetic connective tissue disorders or those who engage in heavy lifting or high-impact activities may also develop prolapse at younger ages.

References:

• Mayo Clinic – Pelvic Organ Prolapse
• American College of Obstetricians and Gynecologists – Pelvic Support Problems
• National Institute of Child Health and Human Development – Pelvic Floor Disorders
• NHS – Pelvic Organ Prolapse
• Johns Hopkins Medicine – Pelvic Organ Prolapse
• Cleveland Clinic – Pelvic Organ Prolapse